UPDATED Jan. 25, 2017: The video of Dr. Nevin’s presentation is now available on the TEDx YouTube channel and below.
Addressing the cost of health care means not only treating people when they are sick, but helping them to stay well. Innovative tools such as Christiana Care Health System’s care coordination program are making this possible, said President and CEO Janice E. Nevin, M.D., MPH, in her TEDx Wilmington Talk “Better Health at Lower Cost — Absolutely!” Dec. 6 at the Hagley Museum.
“In the U.S. we are really good — often the best in the world — at sickness care,” Dr. Nevin told the audience in the packed auditorium at Hagley’s Soda House. “That is the care we get in the hospital, the emergency room, the crisis center. It is testing and treating illness.
“But there’s something else — something very important — that we need from health care that we are not getting.”
The missing link to optimal health is addressing the gaps between sicknesses and health crises. It is ensuring that patients’ social and behavioral health needs — with their great impact on health — are being met, in addition to their medical needs.
“It’s about giving people the right care in the right place at the right time,” Dr. Nevin said. “That will get us to better health at lower cost — to value.”
This proactive approach is most important for people with chronic illness — conditions like diabetes, heart failure and asthma, she explained. Some 45 percent of all Americans have at least one chronic condition, and 81 percent of people in the hospital at any one time are there for complications of chronic illness.
Chronic illness is costly in human terms and in financial terms. Half of all money spent on health care in the U.S. is spent on 5 percent of the population — and the great majority of that 5 percent has one or more chronic illnesses.
“This doesn’t have to be,” Dr. Nevin said. “Chronic diseases can be managed in a way that improves health and allows patients to stay at home and out of the hospital, living in ways that are meaningful and valuable to them.”
Christiana Care CareVio, a new approach to managing chronic illness, is helping patients achieve optimal health, enhancing patient experience and reducing cost.
A unique care-management program, CareVio uses health data and predictive analytics to assess a patient’s health and risk for illness or relapse. The CareVio team of nurses, physicians, social workers and pharmacists focuses on individuals at greatest risk and provides customized care in ways that best suit each patient’s needs.
CareVio teams monitor about 4,000 high-risk patients at any given time through computer algorithms that comb real-time patient data from a wide variety of sources, including the Delaware Health Information Network. The information can include hospital admissions, emergency department visits, physician appointments, lab results, pharmaceutical use and claims data. The system recognizes patterns of care often needed by particular disease populations, enabling case managers — some of whom are embedded in physicians’ offices and the hospital — to be proactive about patients’ needs.
In its first six months, CareVio has reduced readmissions to the hospital, decreased emergency department visits and improved outcomes after surgery. Early data show savings in the millions.
CareVio, said Dr. Nevin, demonstrates that “we can get the care we need and the health we deserve at a cost that is affordable to us and to society. That is sustainable value.”
Other speakers at the TEDx Wilmington Salon, themed “Investing in Opportunity, Managing for Risk” and sponsored by Brown Advisory, were Atnre Alleyne of the Delaware Campaign for Achievement Now on “Why Investing in Public Education Is So Risky” and Dune Thorne of Brown Advisory on women reaching their full professional potential with “Jump to the New S Curve: Unleash the Power of Inclusion.”